A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3

A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

A client taking warfarin (Coumadin) presents with bruises, dark tarry stools and an INR is 4.3. What should the nurse do? Answers: Give the Coumadin with a dark green salad and check her next stool for blood. Give an ampule of Vitamin K, then call the physician to confer about her status Explain to her family that she may have leukemia, and ask they want to have her tested for it. Hold the Coumadin and consult the physician about next steps.

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Give an ampule of Vitamin K, then call the physician to confer about her status. Warfarin is a drug that requires cautious and continuous checking to ensure that you are as a rule enough trea… A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

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Chapter 22: Drugs Used to Treat Dyslipidemias My Nursing Test Banks

 

Chapter 22: Drugs Used to Treat Dyslipidemias

Test Bank

MULTIPLE CHOICE

1. Which lipoprotein contributes to the development of atherosclerosis?

a.

Chylomicrons

b.

Very-low-density lipoprotein (VLDL)

c.

Low-density lipoprotein chylomicron (LDL C)

d.

High-density lipoprotein chylomicron (HDL C)

ANS: C

The probability that atherosclerosis will develop is related directly to the concentration of LDL C. Chylomicrons are intermediate-density lipoproteins. VLDLs are not as important in the development of atherosclerosis as low-density lipoproteins. HDLs do not contribute to the development of atherosclerosis.

DIF: Cognitive Level: Comprehension REF: p. 344 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. The nurse is preparing medications for a patient. When is the best time for the nurse to administer lovastatin (Mevacor)?

a.

2 hours after breakfast

b.

During the patients dinner

c.

1 hour before breakfast

d.

30 minutes before lunch

ANS: B

Lovastatin should be administered with food to enhance absorption, and in the evening, because this is when the production of cholesterol is at its highest. It is not recommended that lovastatin be taken after food but while eating to enhance absorption. Taking the medication a half hour or an hour before eating would not benefit the patient or enhance absorption.

DIF: Cognitive Level: Application REF: pp. 350-351 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. The nurse has completed an admitting patient history and notes the patients current medications to be simvastatin (Zocor) and warfarin (Coumadin). What is the result of the interaction of these drugs?

a.

Abdominal distention

b.

Increased INR

c.

Low serum level of simvastatin

d.

Hypertension

ANS: B

The combined therapy of simvastatin and warfarin may prolong the patients INR. Additional nursing assessments would include monitoring for possible overcoagulation and bleeding. Abdominal distention and a low serum level of simvastatin does not occur with the combined therapy of simvastatin and warfarin. Increased blood pressure is not a complication of combining simvastatin and warfarin therapy.

DIF: Cognitive Level: Comprehension REF: p. 353 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which deficiency may develop in patients taking cholestyramine?

a.

Potassium deficiency

b.

Sodium deficiency

c.

Vitamin K deficiency

d.

Hydrochloric acid deficiency

ANS: C

Patients on long term bile acidsequestering resin therapy may become deficient in fat soluble vitamins (i.e., D, E, A, K). Cholestyramine does not affect electrolyte levels or hydrochloric acid. A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

DIF: Cognitive Level: Knowledge REF: p. 348 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

5. A patient is prescribed a bile acid resin. The nurse instructs the patient to report which adverse reaction related to vitamin K deficiency?

a.

Constipation

b.

Coffee ground emesis

c.

Nausea

d.

Changes in skin pigmentation

ANS: B

Vitamin K is essential for blood clotting. Signs and symptoms of a vitamin K deficiency include bleeding gums, bruising, dark tarry stools, and coffee ground emesis (blood vomited from the stomach). Constipation, nausea, and a change in skin pigmentation are not signs of vitamin K deficiency.

DIF: Cognitive Level: Application REF: p. 347 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. Which vitamin has antilipemic actions?

a.

C

b.

A

c.

D

d.

B3

ANS: D

It is thought that niacin inhibits VLDL synthesis by liver cells, causing a decrease in LDL and triglyceride production. Vitamins A, C, and D do not have an antilipemic effects.

DIF: Cognitive Level: Knowledge REF: p. 349 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

7. Why are statins, or HMG CoA reductase inhibitors, administered at bedtime?

a.

The stomach is empty.

b.

Metabolic needs of the body are decreased.

c.

Cholesterol production is at its peak.

d.

The body temperature is increased.

ANS: C

The peak production of cholesterol is during the night. Therefore, HMG CoA reductase inhibitors are more effective when administered at bedtime. Statins should be taken with food, not on an empty stomach. Metabolic needs of the body and body temperature do not affect the administration of statins.

DIF: Cognitive Level: Comprehension REF: p. 350 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

8. What is the desired effect of any antilipemic therapy?

a.

Reduced LDLs and total cholesterol levels

b.

Reduced HDLs and total cholesterol levels

c.

Reduced LDLs and HDLs

d.

Reduced HDLs and dietary cholesterol levels

ANS: A

LDLs account for 60% to 70% of total serum cholesterol and are a major contributor to atherosclerosis. The therapeutic outcome of antilipemic therapy is to lower the LDL and total cholesterol levels and raise the HDL and HDL/LDL ratio. HDLs are not reduced in treating hyperlipidemia.

DIF: Cognitive Level: Comprehension REF: pp. 344-346 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

9. In addition to controlling hyperlipidemia, what are bile acidbinding resins prescribed to treat?

a.

Constipation secondary to excess fecal bile acids

b.

Constipation related to pseudomembranous colitis

c.

Pruritus secondary to biliary stasis

d.

Jaundice related to cholelithiasis

ANS: C

Bile acidbinding resins may be used to treat pruritus as a result of partial biliary stasis. Excess fecal bile acids produce diarrhea. Pseudomembranous colitis produces diarrhea. Bile acidbinding resins are not used to treat jaundice.

DIF: Cognitive Level: Comprehension REF: p. 348 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which antilipemic agent is most potent?

a.

Niacin

b.

HMG CoA reductase inhibitor

c.

Bile acidbinding resin

d.

Fibric acid

ANS: B

HMG CoA reductase inhibitors are the most potent antilipemic agents available. Niacin, bile acidbinding resins, and fibric acid are not as potent as HMG CoA reductase inhibitors.

DIF: Cognitive Level: Knowledge REF: p. 350 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse is teaching a patient about statin therapy. Which statement by the patient indicates a need for further teaching?

a.

I will take this medication at night.

b.

This medication will reduce blood clot formation.

c.

I will avoid drinking grapefruit juice.

d.

If I get a headache, I will notify my health care provider.

ANS: D

Headaches are usually mild and disappear with continued therapy. Statins are to be taken at night. Statins reduce blood clot formation by reducing platelet aggregation and thrombin formation. Grapefruit juice inhibits the metabolism of this medication.

DIF: Cognitive Level: Application REF: p. 350 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. The nurse is providing education to a patient who has recently been prescribed niacin. Which information given by the nurse is accurate?

a.

Weigh yourself weekly because of the risk of fluid retention.

b.

Nausea can be decreased if you take this medication with food.

c.

Because your blood pressure may increase while taking this drug, have it checked monthly.

d.

You should not take aspirin while on this medication.

ANS: B

Niacin is administered with food to decrease gastrointestinal (GI) upset. Fluid retention and increased blood pressure are not adverse effects of niacin. Aspirin can minimize adverse effects and is safe to take.

DIF: Cognitive Level: Application REF: p. 349 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The nurse is assessing a patient who is being evaluated for hyperlipidemia. Which assessment will most increase the risk of coronary artery disease (CAD)? A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

a.

Blood pressure, 168/90 mm Hg

b.

Hemoglobin A1c, 6%

c.

Walks 3 miles briskly, usually 4 days a week

d.

Eats five servings of fruits and vegetables daily

ANS: A

Major treatable causes of CAD are hypertension, cigarette smoking, type 2 diabetes mellitus, and atherosclerosis. A hemoglobin A1c level of 6% does not increase the risk for CAD. Exercise and eating fruits and vegetables decrease the risk for CAD.

DIF: Cognitive Level: Application REF: p. 344 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

14. A patient is taking a HMG CoA reductase inhibitor and reports muscle aches, soreness, and weakness. The nurse suspects these symptoms to indicate early signs of myopathy. When notifying the physician of these symptoms, the nurse will also be sure to report the results of the patients:

a.

serum creatine phosphokinase levels.

b.

red blood cell count.

c.

urine culture.

d.

echocardiogram.

ANS: A

Serum creatine phosphokinase levels more than 10 times the upper limit of normal confirm the diagnosis of myopathy. Red blood cell and urine cultures and an echocardiogram would not confirm the diagnosis of myopathy.

DIF: Cognitive Level: Application REF: p. 352 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

15. The nurse is educating a patient about niacin prescribed to treat his hyperlipidemia. Which important teaching point(s) should be included in the educational plan? (Select all that apply.)

a.

Effectiveness of niacin in lowering total cholesterol

b.

Information on high cholesterol foods and food preparation using unsaturated fats

c.

Importance of smoking cessation and daily exercise

d.

Alternative funding resource information because of the high cost of niacin

e.

Adverse effects to report (e.g., fatigue, anorexia, nausea, malaise, jaundice, muscle aches)

ANS: A, B, E

Therapeutic outcomes expected with niacin use include reduction in LDL and total cholesterol levels, reduction in triglyceride levels, and increase in HDL levels. Niacin is used in conjunction with dietary therapy to decrease elevated cholesterol concentrations in hyperlipidemia and to reduce the risks of atherosclerosis leading to coronary heart disease. Initial adverse effects to expect include nausea, gas, abdominal discomfort, dizziness, faintness, and hypotension. Jaundice, malaise, muscle aches, and anorexia should be reported to the health care provider. Although these are healthy lifestyle behaviors, they are not indicated in patient teaching about antilipemic medications. Niacin is not expensive in comparison with other antilipemic medications.

DIF: Cognitive Level: Application REF: p. 349 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. Which nutritional concept(s) is/are necessary to provide to patients receiving colestipol? (Select all that apply.)

a.

Take on an empty stomach to enhance absorption.

b.

Whole grains, raw fruits, and vegetables will minimize constipation.

c.

Drink eight to ten 8 ounce glasses of water daily to eliminate dehydration that results from frequent loose stools.

d.

Report signs of vitamin K deficiency, including bleeding gums, dark tarry stools, and coffee ground emesis.

e.

Supplemental fat soluble vitamins may be necessary.

ANS: B, D, E

Adequate fluid and fiber in the diet will help prevent constipation, as well as additional expected GI adverse effects. High doses of resins may reduce absorption of fat soluble vitamins; this interaction is not usually significant in normally nourished patients. If these severe symptoms appear, they should be reported to the health care provider. Patients who are taking bile acidsequestering resins may require supplemental fat soluble vitamin therapy (A, D, E, K). The recommended time of administration is with meals, but this may be modified to avoid interference with absorption of other medications. Constipation is a more likely adverse effect than loose stools.

DIF: Cognitive Level: Application REF: p. 348 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. A teaching plan for a patient with hyperlipidemia would instruct the patient to avoid which food(s)? (Select all that apply.) A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

a.

Hard cheeses

b.

Egg whites

c.

Unsaturated vegetable oils

d.

Green vegetables

e.

Liver

ANS: A, E

Patients with hyperlipidemia should avoid foods high in cholesterol, such as cheeses and organ meats. Egg whites, unsaturated vegetable oils, and green vegetables do not negatively affect hyperlipidemia.

DIF: Cognitive Level: Analysis REF: pp. 345-346 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

18. What will the nurse review when teaching a patient about therapy with statins? (Select all that apply.)

a.

Statins are the most potent antilipemic agents available.

b.

Statins should be taken with food.

c.

Statins replace dietary therapy for the control of hyperlipidemia.

d.

Statins cause mild increases in HDL levels.

e.

Statins are administered in the morning when cholesterol production is high.

f.

Statins reduce inflammation, platelet aggregation, and plasma viscosity.

ANS: A, B, D, F

Statins are the most potent drugs available for treatment of hyperlipidemia, should be taken with food, may increase HDL levels, and reduce inflammation, platelet aggregation, and plasma viscosity. Statins are used in conjunction with dietary therapy; they do not replace it. Cholesterol production is highest at night, so statins should be taken at night with food.

DIF: Cognitive Level: Comprehension REF: p. 350 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

19. The nurse transcribes a new order for Lovaza on a patient in a long term care facility. When providing education to the patient about this medication, the nurse will include which statement(s)? (Select all that apply.)

a.

Liver function tests should be completed before initiating therapy.

b.

Lovaza is available in tablet form.

c.

Triglyceride levels should increase with use.

d.

Lovaza should be used with caution if the patient has an allergy to fish.

e.

Lovaza does not cause myositis.

ANS: A, D, E

Liver function tests (AST, ALT) should be completed before initiating therapy and every 6 to 8 weeks during the first year of therapy with Lovaza. Lovaza should be used with caution if patients have an allergy or sensitivity to fish. Lovaza may have an advantage over the fibrates and niacin because it does not cause myositis or rhabdomyolysis. Lovaza is not available in tablet form; it is in capsule form. Triglyceride levels should be reduced.

DIF: Cognitive Level: Application REF: p. 354 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

20. The nurse is preparing to administer niacin for the first time to a patient being treated for dyslipidemia. Before administering this medication, the nurse will assess: (Select all that apply.)

a.

blood glucose levels.

b.

blood pressure.

c.

heart rate.

d.

temperature.

e.

oxygen saturation.

ANS: A, B, C

Baseline blood glucose, blood pressure, and heart rate should be determined before initiating niacin therapy. Temperature and oxygen saturation levels are not necessary prior to administering niacin.

DIF: Cognitive Level: Application REF: p. 349 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity. A client taking warfarin/ Coumadin presents with bruises, dark tarry stools and an INR is 4.3.

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